Healthcare Provider Details

I. General information

NPI: 1548371933
Provider Name (Legal Business Name): DR. JUAN RAMON ESCOBAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 HOUMA BLVD STE 100
METAIRIE LA
70006-2943
US

IV. Provider business mailing address

PO BOX 1177
HARVEY LA
70059-1177
US

V. Phone/Fax

Practice location:
  • Phone: 504-349-6330
  • Fax:
Mailing address:
  • Phone: 504-349-6330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number10264
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: